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Thursday, September 17 · 29 stories
- Managed Care
Eighteen Health Plans Score 5 Stars in NCQA 2026 Ratings, No For-Profits Included
Eighteen health plans achieved perfect 5-star ratings in NCQA's 2026 standards ratings, up from 11 in the previous cycle. None of the top-scoring plans are for-profit entities. The ratings measure plan performance across quality, access, and member experience metrics. The results highlight a continuing performance gap between nonprofit and for-profit health plans on nationally standardized quality measures.
- Industry
FDA Faces Staff Shortage That Hampers Agency's Ability to Expand Workforce
The Food and Drug Administration is experiencing a hiring bottleneck due to insufficient staffing resources to recruit and onboard new employees. This operational constraint affects the agency's ability to scale up its workforce even when funding and positions are authorized. The staffing limitation comes as FDA faces increasing regulatory responsibilities across drug approvals, medical device oversight, and food safety. While not directly a Medicaid story, this affects the broader regulatory environment in which Medicaid operates, particularly for drug approvals and medical device reviews that impact Medicaid coverage and spending decisions.
- Federal Policy · CT
CMS Awards Connecticut $50 Million for Rural Hospital Infrastructure and Care Delivery
CMS announced $50 million in federal funding to Connecticut to support rural hospital infrastructure improvements and optimize care delivery systems. The funding targets rural hospital facilities and care coordination in underserved areas. Implementation timing and specific program requirements were not detailed in the announcement. The funding represents significant federal investment in rural healthcare capacity, potentially affecting Medicaid beneficiaries who rely on rural hospital access for both inpatient and emergency services.
- Federal Policy
HHS Secretary Kennedy Appoints Eight Members to U.S. Preventive Services Task Force
HHS Secretary Robert F. Kennedy Jr. appointed eight new members to the U.S. Preventive Services Task Force on September 17, 2026, through the Agency for Healthcare Research and Quality, bringing the panel to 16 total members. The task force issues evidence-based recommendations on clinical preventive services including screenings, counseling, and preventive medications. These recommendations directly affect Medicaid coverage requirements under the Affordable Care Act, which mandates coverage of USPSTF Grade A and B services without cost-sharing for certain populations.
- Federal Policy · SC
CMS Awards $167 Million to South Carolina for Rural Infrastructure and Health Technology
CMS announced $167 million in federal funding to South Carolina for rural health care infrastructure, health technology upgrades, and prevention programs. The funding will support construction of rural care sites and modernization of health IT systems. The announcement did not specify eligibility or implementation timelines. This matters for South Carolina Medicaid providers and health plans operating in rural service areas, as infrastructure investments may affect network capacity and care delivery models.
- Legal · NC
OIG Finds North Carolina Medicaid Fraud Control Unit Compliant in 2025 Inspection
The HHS Office of Inspector General conducted an onsite inspection of North Carolina's Medicaid Fraud Control Unit in 2025 and found the unit in compliance with federal certification standards. The inspection reviewed the unit's investigative capacity, case management procedures, staffing levels, and coordination with state Medicaid agencies and law enforcement partners. MFCU certification is required for states to receive federal matching funds for fraud control activities. The findings confirm North Carolina maintains adequate resources and protocols to investigate and prosecute Medicaid provider fraud and beneficiary abuse.
- State Policy · IN
Indiana Proposes Expanded Resident Rights and HCBS Standards for Residential Care Facilities
The Indiana Department of Health has issued a second public comment notice on proposed amendments to Residential Care Facility regulations. The rulemaking would expand resident rights protections, incorporate federal Home and Community-Based Services setting requirements into state assisted living regulations, and create new eviction procedures for facilities. The proposal affects residential care facilities serving Medicaid HCBS waiver beneficiaries in Indiana. Public comment is now open on the revised proposal, which builds on an earlier version published this year.
- Federal Policy
GAO Finds CMS Oversight of State Medicaid Eligibility Error Corrective Actions Inadequate
The Government Accountability Office concluded that CMS inconsistently enforces required evaluations and conducts limited analysis of state corrective action plans (CAPs) addressing Medicaid eligibility errors identified through Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs. CMS accepted CAPs missing federally required elements and does not systematically analyze errors and corrective actions across states to determine effectiveness. GAO reviewed PERM reports from 2019-2025 and MEQC results from seven states, finding caseworkers were the most prevalent root cause of errors, with specific causes falling into four categories including verification failures and system processing errors. GAO recommends CMS collect all required CAP elements and conduct cross-state analyses to better support states in reducing eligibility errors and improper payments.
- State Policy · TX
Texas Hospitals Regain $12 Billion in Medicaid Funding After Federal Dispute Resolved
Texas hospitals will receive $12 billion in Medicaid funding following resolution of a nearly year-long dispute with CMS. The impasse had threatened hospitals with $27 million in daily losses. The restoration of funds ends uncertainty over supplemental payment programs that support hospitals serving Medicaid and uninsured populations. The resolution allows Texas to continue making these payments under terms acceptable to federal regulators.
- Legal · TX
Texas Family Sues Attorney General Paxton Over Denied Abortion Leading to Maternal Death
The family of Tierra Walker, a 37-year-old Texas woman who died from preeclampsia in 2024, filed a lawsuit Wednesday against Texas Attorney General Ken Paxton and doctors who denied her an abortion. Walker experienced seizures, blood clots, and hypertensive crisis at four months pregnant and requested abortion care multiple times before her death. The lawsuit challenges enforcement of Texas abortion restrictions that allegedly prevented medically necessary care. This case follows several wrongful death and civil rights lawsuits filed nationwide challenging state abortion laws and their impact on maternal health outcomes.
- State Policy · VT
Vermont Physician Argues Against Cutting Graduate Medical Education Funding Amid Federal Medicaid Reductions
A Vermont physician defends graduate medical education (GME) investment in response to recent state debate about physician training costs and retention rates. The letter notes that commercial payers are bearing increased GME costs as federal Medicaid dollars decline and federal funding for public health and substance use programs is cut. Vermont's physician retention rate trails the national average, which the author attributes to the state's challenging healthcare climate and reliance on federal grants rather than state funding for residency programs. The letter opposes cutting medical education as a cost-control measure.
- State Policy · WV
West Virginia Legislator Questions $1.17M Rural Health Grant to Wellness Organization
West Virginia awarded Spotted Owl Health Organization $1.17 million in federal Rural Health Transformation program funds to establish employer-based worksite clinics, prompting concerns from Del. Gary Howell that the Kanawha County wellness organization lacks experience in multi-employer healthcare delivery and has never administered grants exceeding $50,000. Health Secretary Arvin Singh defended the merit-based selection and noted the state can claw back funding if performance milestones are not met. West Virginia received $199 million in Rural Health Transformation program funding from CMS for 2026, part of a five-year initiative to expand rural healthcare access.
- Federal Policy · CT
Four Connecticut Rural Hospitals Receive $46 Million in Federal Rural Health Grants
Charlotte Hungerford, Day Kimball, Sharon, and Windham Hospitals received $46 million in federal grants through the Rural Health Transformation Program to expand imaging, telehealth, and transport services. Day Kimball Hospital received the largest share at $20.2 million to replace trailer-based MRI services and expand patient monitoring. Connecticut received $154 million total under the program, with the remaining $104 million funding workforce development, maternity services, and mobile health initiatives across the state. CMS monitors fund deployment through annual progress reports that determine subsequent funding levels.
- Managed Care
National Health Law Program Calls for State Enforcement of Behavioral Health Network Adequacy Standards
The National Health Law Program is urging states to strengthen enforcement of network adequacy requirements for behavioral health services in Medicaid managed care plans. The organization highlights gaps in provider networks that leave enrollees unable to access timely mental health and substance use disorder treatment. States have existing authority under federal Medicaid managed care regulations to monitor network adequacy through time and distance standards, appointment wait times, and secret shopper surveys. The recommendation comes as states face ongoing challenges ensuring adequate behavioral health provider networks in managed care arrangements.
- Federal Policy
21.4 Million U.S. Women Face Limited Access to Subsidized Contraception, New Analysis Finds
Power to Decide and Guttmacher Institute released updated county-level maps showing 21.4 million women needing subsidized contraception live in counties with limited access to publicly-funded family planning clinics. The analysis measures clinic capacity against demand among women earning under 250% of federal poverty level, revealing widespread gaps in Title X-funded services. Maricopa County, Arizona exemplifies the challenge with 29 publicly-funded clinics serving only 8% of nearly 300,000 women in need. The methodology focuses on brick-and-mortar clinics receiving federal or state family planning funds, using patient caseloads to estimate capacity and National Survey of Family Growth data to identify women who would use contraception if cost were not a barrier.
- Federal Policy
WEDI Opens Survey on CMS Prior Authorization Rule Readiness Through Oct. 9
The Workgroup for Electronic Data Interchange has launched a survey to assess industry readiness for CMS's interoperability and prior authorization final rule, with responses open through Oct. 9, 2026. The anonymous survey will gather aggregated data from health plans, providers, and other stakeholders on their implementation progress. WEDI will use the results to develop recommendations for CMS, inform stakeholders, and create industry guidance and educational materials on electronic prior authorization standards compliance.
- State Policy · NH
New Hampshire ACA Marketplace Enrollment Falls 8% After Enhanced Premium Tax Credits Expire
New Hampshire saw 4,868 fewer residents enrolled in ACA Marketplace plans in 2026 compared to 2025, an 8% decline, following the December 2025 expiration of Enhanced Premium Tax Credits. Nationally, enrollment dropped from 21.8 million to 19.2 million. The analysis by KFF used effectuated enrollment data, which reflects both non-enrollment and coverage loss due to non-payment of premiums. The decline coincides with broader federal Medicaid cuts under the One Big Beautiful Bill Act and new state Medicaid premium requirements in New Hampshire, raising concerns among community health providers about access to primary care and emergency department utilization.
- Federal Policy
CMS Renews DNV Healthcare Recognition as Hospital Accrediting Organization
CMS has approved DNV Healthcare USA Inc.'s application for continued recognition as a national accrediting organization for hospitals seeking Medicare or Medicaid participation. The approval allows DNV to continue surveying hospitals for compliance with CMS Conditions of Participation. The renewal takes effect September 17, 2026. This maintains DNV's status as one of several deemed status organizations that perform accreditation surveys in lieu of direct CMS or state agency surveys.
- State Policy · OR
Oregon Medicaid Overpaid $4.1M Due to Duplicate Enrollee IDs, Audit Finds
A state audit found Oregon's Medicaid program overpaid up to $4.1 million to healthcare organizations statewide due to duplicate enrollee identification codes that state officials failed to detect and correct. The system errors resulted in improper claims payments when the same beneficiaries were issued multiple IDs. The audit did not specify a timeline for recovery or corrective action, but the findings indicate ongoing financial integrity and claims processing vulnerabilities in Oregon's Medicaid system.
- State Policy · CO
Colorado Pediatric Clinics Close as Medicaid Cuts, Federal Eligibility Changes Hit Children's Coverage
Federal Medicaid cuts totaling $1 trillion and a 2% Colorado state reimbursement rate reduction are forcing pediatric clinic closures and coverage losses for children. Two pediatric clinics within 10 miles of Commerce City have closed entirely due to insufficient revenues. On October 1, 2026, new federal rules will cut Medicaid eligibility for immigrant children, affecting an estimated 7,000 Colorado children. Colorado projects up to 377,000 total Medicaid enrollees at risk of disenrollment, with children representing more than one-third of the state's Medicaid population.
